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HomeMy Public PortalAbout9944 OLIVE ST_Plumbing__ WORKERS'aCOMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT I her' Y$�'firm that Move a certificate of consent to self 20-0026 DPW 6/87 �, I irisu,., or a certificate of Workers'Compensation Insurance, 76A667A luf ora c6rtified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. p (� y.. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS 9-L 4 T E , OL IVEST �MPt e C t Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appliqant 1 WATER CLOSET ,� �,. NEAREST IV CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. , COMPENSATION INSURANCE r SHOWER OWNER t4(4(0 Fe k(4- i w w (This section need not be completed if the work Involved by IL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS Q E , OL IVE ' % I certify that in the performance of the work for which this y permit is issued,I shall not employ any person in any manner SINK CITY TE/7 tce C r TEL.NO. rl r 3J26 so as to become subject to the Workers'Compensation Laws. DISHWASHER //n CONTRACTOR Date r y/�-C 2 072 Applicant � CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after aking this Cer ficate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO.� G PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL I VALIDATION a DATE (Z--IQ License Number Lic. Class C7 FINAL M Contractor Date BY C ❑ I am exempt under Sec. W B.BP.C. for this reason ® n' Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 3 Signature TOTAL FEE 3 Pian check applicant 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address } Law for the following reason (Section 7031.5, Business and It Professions Code): City Tel. No. a a © I, as owner of the property, will do the work and the y structure is not intended or offered for sale (Section ® iI_TAL3 s 0 0 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY C SIE`i I hereby affirm that there is a construction lending agency for t.`l ii�i1� IL the performance of the work for which this permit is issued (Sec. 3097,Civ. C.). 17 + Lender's Name Lender's Address us#6 1 AN ;1_34 4 I certify that I have read this application and state that the above information is correct. I agree to comply with all County 110. ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned pr perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE IV,A-. zT 4/ Si ature of Permitte Date it ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1009280004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ITR: 6755 IT: 10 BL: .001 I 1 9944 OLIVE ST 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT.1 TEMP CA 917803238 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BALDWIN I I8589-005-005 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 1.00 FIX 16.30 1 1 TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.30 ISSUED ON: PROCESSED BY: PLAN BY: 145 WATER CLOSET/URINAL 1.00 FIX 16.30 09/28/10 SR I I TOTAL FEES 76.70 I I (OWNER: TEL. NO: I 1F2 DATE FIN/p�,1BY: CODE: 1VBRONIKA 9944 OLIVE 9944 OLIVE ST TEMP 917803238 1 1DE CRIPTION OF WORK 1 IPLUMBING FOR NEW BATHROOM 1 1APPLICANT: TEL. NO: I I I IVICTOR FELIX (323) 215-9783- I I 1 1 1 ISPECIAL CONDITIONS: I I I I I I I I I CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 CEM CONSTRUCTION INC. (760) 792-6523- 1 I I 18207 BROOKGREEN RD LIC. NO I (UNDER SLAB WORK I IDOWNEY, CA 90240 941346 B 1 1 I IWATER SERVICE I ILI 1 IPLASTIC Y/N METAL YIN 1 I 1 (ARCHITECT OR ENGINEER: TEL. NO: I I I I I IMENDOZA, RAMON (323) 724-8333- 1 IROUGH PLUMBING 1 1 12161 S. EASTERN AVE. LIC. NO: I I 1 (COMMERCE C25255 ' IGAS PIPING I I IGAS VENT 1 1 1 I I I 1 I I I I IHOT WATER HEATER I 1 1 I I I I I I IPLUMBING FIXTURES I I I I I I I I I ILAWN SPRINKLERS 1 1 1 I I I I I I I IGAS TEST I I 1 II (UTILITY COMPANY NOTIFIED I I 1CWv I I I I 1 (GRAY WATER SYSTEM 1 I I I I I 1 1 I I 1 I I I I I I I I I I I I III 1 1 I I I i I I I IREPORT ID: DPR263 ROUTE TO: BS0508 1 1 1 1 I I I I I I